Provider Demographics
NPI:1740935311
Name:MACHIN, LAURA (OWN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MACHIN
Suffix:
Gender:
Credentials:OWN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26450 SW 146TH CT APT 305
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6532
Mailing Address - Country:US
Mailing Address - Phone:561-808-3890
Mailing Address - Fax:
Practice Address - Street 1:26450 SW 146TH CT APT 305
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6532
Practice Address - Country:US
Practice Address - Phone:561-808-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119246106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107272400Medicaid